The U.S. Centers for Disease Control and Prevention (CDC) has released a guideline for the diagnosis, prognosis, and treatment of mild traumatic brain injury (mTBI) in children -- including recommendations regarding head imaging -- in a September 4 publication in JAMA Pediatrics.
The CDC established a federal advisory committee, the Pediatric Mild Traumatic Brain Injury Guideline Workgroup, to conduct a systematic review of relevant evidence and expert opinion on pediatric mTBI that was published between January 1990 and July 2015.
Among 19 sets of recommendations detailed in the final guideline, one of the sections specifically addresses the role of medical imaging in diagnosing the condition. The guideline recommends against the routine use of head CT, MRI, SPECT, or x-ray for the evaluation of suspected or diagnosed mTBI in children.
Though several studies examined in the review demonstrated the potential of CT to identify intracranial injury in 5.2% to 7.5% of pediatric mTBI cases, all of the findings were associated with low confidence. The committee additionally cited a number of potential disadvantages of neuroimaging, including increased costs, need for sedation, and radiation exposure.
Instead, the committee favored the use of validated clinical decision rules to diagnose pediatric mTBI. An initial assessment based on decision rules could then drive clinicians to request a head CT exam or further workup for patients with a high risk of intracranial injury.
![Images show the pectoralis muscles of a healthy male individual who never smoked (age, 66 years; height, 178 cm; body mass index [BMI, calculated as weight in kilograms divided by height in meters squared], 28.4; number of cigarette pack-years, 0; forced expiratory volume in 1 second [FEV1], 97.6% predicted; FEV1: forced vital capacity [FVC] ratio, 0.71; pectoralis muscle area [PMA], 59.4 cm2; pectoralis muscle volume [PMV], 764 cm3) and a male individual with a smoking history and chronic obstructive pulmonary disorder (COPD) (age, 66 years; height, 178 cm; BMI, 27.5; number of cigarette pack-years, 43.2, FEV1, 48% predicted; FEV1:FVC, 0.56; PMA, 35 cm2; PMV, 480.8 cm3) from the Canadian Cohort Obstructive Lung Disease (i.e., CanCOLD) study. The CT image is shown in the axial plane. The PMV is automatically extracted using the developed deep learning model and overlayed onto the lungs for visual clarity.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/03/genkin.25LqljVF0y.jpg?auto=format%2Ccompress&crop=focalpoint&dpr=2&fit=crop&h=167&q=70&w=250)